Weight concerns, weight control behaviors, and smoking initiation

Trajectories of body mass index and combustible and electronic cigarette use across adolescence: Findings from the PATH study

PURPOSE

Associations between empirically-generated body mass index (BMI) trajectories and risk of current use of combustible cigarettes and e-cigarettes across adolescence were examined using longitudinal data from the Population Assessment of Tobacco and Health (PATH) study.

METHODS

The PATH study is an ongoing annual longitudinal population-based study of adolescents. We utilized Waves 1-4 conducted from 2013 to 2017. Adolescents completed self-reported surveys of their height, weight, and current tobacco use at Waves 1-4 and their tobacco weight control beliefs at Waves 1-2.

RESULTS

Using latent growth mixture modeling, six trajectories of BMI were identified. The largest group ("normal weight increasing;" n = 4,858; 86.6 %), which was used as the comparator in subsequent analyses, consisted of adolescents ages 12-17 who were normal weight at Wave 1 with a significant increase in BMI across Waves 2--4. The "overweight early increasing," "overweight late increasing," and "obesity stable" classes had greater likelihood of current combustible cigarette use during the study compared to the "normal weight increasing class." The "overweight early increasing," "overweight late increasing," and "overweight increasing then decreasing" classes showed elevated risk for e-cigarette use during the study. Compared to those in the "normal weight increasing" class, those in the "overweight increasing then decreasing" and "obesity stable" classes had greater weight control beliefs at Wave 1 and those in the "obesity stable" class had greater weight control beliefs at Wave 2.

CONCLUSIONS

Findings highlight the importance of weight trajectories and weight control beliefs by tobacco product use across adolescence and the need for mechanistic and intervention research.

Disentangling the aetiological pathways between body mass index and site-specific cancer risk using tissue-partitioned Mendelian randomisation

BACKGROUND

Body mass index (BMI) is known to influence the risk of various site-specific cancers, however, dissecting which subcomponents of this heterogenous risk factor are predominantly responsible for driving disease effects has proven difficult to establish. We have leveraged tissue-specific gene expression to separate the effects of distinct phenotypes underlying BMI on the risk of seven site-specific cancers.

METHODS

SNP-exposure estimates were weighted in a multivariable Mendelian randomisation analysis by their evidence for colocalization with subcutaneous adipose- and brain-tissue-derived gene expression using a recently developed methodology.

RESULTS

Our results provide evidence that brain-tissue-derived BMI variants are predominantly responsible for driving the genetically predicted effect of BMI on lung cancer (OR: 1.17; 95% CI: 1.01-1.36; P = 0.03). Similar findings were identified when analysing cigarettes per day as an outcome (Beta = 0.44; 95% CI: 0.26-0.61; P = 1.62 × 10-6), highlighting a possible shared aetiology or mediator effect between brain-tissue BMI, smoking and lung cancer. Our results additionally suggest that adipose-tissue-derived BMI variants may predominantly drive the effect of BMI and increased risk for endometrial cancer (OR: 1.71; 95% CI: 1.07-2.74; P = 0.02), highlighting a putatively important role in the aetiology of endometrial cancer.

CONCLUSIONS

The study provides valuable insight into the divergent underlying pathways between BMI and the risk of site-specific cancers.

Simultaneous estimation of bi-directional causal effects and heritable confounding from GWAS summary statistics

Mendelian Randomisation (MR) is an increasingly popular approach that estimates the causal effect of risk factors on complex human traits. While it has seen several extensions that relax its basic assumptions, most suffer from two major limitations; their under-exploitation of genome-wide markers, and sensitivity to the presence of a heritable confounder of the exposure-outcome relationship. To overcome these limitations, we propose a Latent Heritable Confounder MR (LHC-MR) method applicable to association summary statistics, which estimates bi-directional causal effects, direct heritabilities, and confounder effects while accounting for sample overlap. We demonstrate that LHC-MR outperforms several existing MR methods in a wide range of simulation settings and apply it to summary statistics of 13 complex traits. Besides several concordant results with other MR methods, LHC-MR unravels new mechanisms (how disease diagnosis might lead to improved lifestyle) and reveals new causal effects (e.g. HDL cholesterol being protective against high systolic blood pressure), hidden from standard MR methods due to a heritable confounder of opposite effect direction.

Intention to lose weight and use of electronic cigarettes among adolescents

Electronic cigarette use among American adolescents is a major public health concern given the negative health consequences of nicotine in youth. Recent literature has shown that weight control may be one motivation for use in this population. This study examined associations between intention to lose weight and e-cigarette use among adolescents having overweight or obesity from an ethnically diverse sample of Texas youth by gender. We performed a cross-sectional analysis of a state representative sample of 9056 eighth and eleventh grade students from the 2015-2016 Texas School Physical Activity and Nutrition (Texas SPAN) study. Validated survey items assessed weight intentions and e-cigarette use. Staff collected anthropometric measures. Logistic regression analysis was conducted to assess the relationship between e-cigarette use and weight intentions with gender interaction, adjusting for grade, race/ethnicity, economic status, weight-behaviors and stratified by BMI class. More than half (50.9%) of the weighted sample were Hispanic and 12.5% were Non-Hispanic Black; 8.5% used e-cigarettes; and 50.0% intended to lose weight. Of the 40.2% of the sample having overweight or obesity, 82.9% intended to lose weight. Among respondents with obesity, use of e-cigarettes was significantly higher among males intending to lose weight than among females intending to lose weight (12% versus 6%, p = 0.007). These findings contrast with previous research suggesting that e-cigarette use in females is more likely to be motivated by an intent to lose weight. The ethnic diversity of the Texas SPAN population may explain this discrepancy.

Body esteem, weight-control outcome expectancies, and e-cigarette use among young adults

INTRODUCTION

Evidence is still scarce regarding the use of e-cigarettes by young people for weight-control reasons. This study aimed to test a model in which the prospective association between negative body esteem and e-cigarette use is mediated by weight-control outcome expectancies for e-cigarette use. The model was tested across genders.

METHODS

Data were collected at three time points, 6 months apart, from 2327 young adults (mean age = 21.2; SD = 2.2; 54% women). Self-reported data were collected on demographics, body mass index, body esteem, weight-control outcome expectancies for e-cigarette use, and current e-cigarette use and cigarette smoking.

RESULTS

Among women, we found a significant indirect effect of lower body esteem on higher likelihood of current e-cigarette use 1 year later, mediated by higher weight-control outcome expectancies at 6-month follow-up, adjusting for demographics, body mass index, and baseline e-cigarette use and cigarette smoking. Among men, body esteem was not found to have significant effect on either weight-control expectancies or e-cigarette use.

CONCLUSIONS

Based on the current findings, young adult women who have higher negative body esteem are at increased risk for using e-cigarettes for weight-control motives.

IMPLICATIONS

The current findings are some of the first to show prospective associations among weight-control motives and e-cigarette use among young adults. These findings suggest that a group of vulnerable young women may be using e-cigarettes to lose or control weight. More research is needed to understand their choice of flavors, nicotine concentration, and device type. In addition, research is needed to understand whether e-cigarettes are being marketed, directly or indirectly, as being useful for weight loss or control. There may be a need for health promotion strategies that provide healthier alternatives to young women struggling with low body esteem who use e-cigarettes for weight loss or control.

Intersection of smoking, e-cigarette use, obesity, and metabolic and bariatric surgery: a systematic review of the current state of evidence

BACKGROUND

Millions of Americans qualify for metabolic and bariatric surgery (MBS) based on the proportion of the population with severe obesity. Simultaneously, the use of electronic nicotine/non-nicotine delivery systems (ENDS) has become epidemic.

OBJECTIVE

We conducted a timely systematic review to examine the impact of tobacco and ENDS use on post-operative health outcomes among MBS patients.

METHODS

PRISMA guidelines were used as the search framework. Keyword combinations of either "smoking," "tobacco," "e-cigarette," "vaping," or "ENDS" and "bariatric surgery," "RYGB," or "sleeve gastrectomy" were used as search terms in PUBMED, Science Direct, and EMBASE. Studies published in English between January 1990 and June 2020 were screened.

RESULTS

From the 3251 articles found, a total of 48 articles were included in the review. No articles described a relationship between ENDS and post-operative health outcomes in MBS patients. Seven studies reported smokers had greater post-MBS weight loss, six studies suggested no relationship between smoking and post-MBS weight loss, and one study reported smoking cessation pre-MBS was related to post-MBS weight gain. Perioperative use of tobacco is positively associated with several post-surgery complications and mortality in MBS patients.

CONCLUSIONS

Combustible tobacco use among MBS patients is significantly related to higher mortality risk and complication rates, but not weight loss. No data currently is available on the impact of ENDS use in these patients. With ENDS use at epidemic levels, it is imperative to determine any potential health effects among patients with severe obesity, and who complete MBS.

Nicotine Effects, Body Weight Concerns and Smoking: A Literature Review

How people become addicted to cigarette smoking and remain addicted despite repeated attempts to quit requires piecing together a rather complex puzzle. The present review contextualizes the role of nicotine and smoking sensory stimulation on maintaining smoking, describes nicotine's effects on feeding behavior and body weight, and explores the impact of smoking outcome expectancies, including the belief that nicotine suppresses appetite and body weight, on the decision to smoke or vape (use of e-cigarettes). The analysis concludes with a review of rat models of human nicotine intake that attempt to isolate the effects of nicotine on appetite and weight gain. Animal research replicates with relative closeness phenomena observed in smokers, but the rat model falls short of replicating the long-term weight gain observed post-smoking cessation.

The effect of body mass index on smoking behaviour and nicotine metabolism: a Mendelian randomization study

Given clear evidence that smoking lowers weight, it is possible that individuals with higher body mass index (BMI) smoke in order to lose or maintain their weight. We performed Mendelian randomization (MR) analyses of the effects of BMI on smoking behaviour in UK Biobank and the Tobacco and Genetics Consortium genome-wide association study (GWAS), on cotinine levels and nicotine metabolite ratio (NMR) in published GWAS and on DNA methylation in the Avon Longitudinal Study of Parents and Children. Our results indicate that higher BMI causally influences lifetime smoking, smoking initiation, smoking heaviness and also DNA methylation at the aryl-hydrocarbon receptor repressor (AHRR) locus, but we do not see evidence for an effect on smoking cessation. While there is no strong evidence that BMI causally influences cotinine levels, suggestive evidence for a negative causal influence on NMR may explain this. There is a causal effect of BMI on smoking, but the relationship is likely to be complex due to opposing effects on behaviour and metabolism.

Body mass index, body dissatisfaction and adolescent smoking initiation

BACKGROUND

Smoking influences body weight, but there is little evidence as to whether body mass index (BMI) and body dissatisfaction increase smoking initiation in adolescents.

METHODS

We evaluated the association between measured BMI, body dissatisfaction and latent classes of smoking initiation (never smokers, experimenters, late onset regular smokers, early onset regular smokers) in the Avon Longitudinal Study of Parents and Children. In observational analyses we used BMI (N=3754) and body dissatisfaction at age 10.5 years (N=3349). In Mendelian randomisation (MR) analysis, we used a BMI genetic risk score of 76 single nucleotide polymorphisms (N=4017).

RESULTS

In females, higher BMI was associated with increased odds of early onset regular smoking (OR: 1.11, 95% CI: 1.04, 1.18) compared to being a never smoker, but not clearly associated with experimenting with smoking (OR: 1.04, 95% CI: 0.99, 1.10) or late onset regular smoking (OR: 1.01, 95% CI: 0.94, 1.09). No clear evidence was found for associations between BMI and smoking initiation classes in males (p-value for sex interaction≤0.001). Body dissatisfaction was associated with increased odds of late-onset regular smoking (OR: 1.71, 95% CI: 1.32, 1.99) in males and females combined (P-value for sex interaction=0.32). There was no clear evidence for an association between the BMI genetic risk score and smoking latent classes in males or females but estimates were imprecise.

CONCLUSIONS

BMI in females and body dissatisfaction in males and females are associated with increased odds of smoking initiation, highlighting these as potentially important factors for consideration in smoking prevention strategies.

Dimensions of Peer Influences and Their Relationship to Adolescents' Aggression, Other Problem Behaviors and Prosocial Behavior

Although peers are a major influence during adolescence, the relative importance of specific mechanisms of peer influence on the development of problem behavior is not well understood. This study investigated five domains of peer influence and their relationships to adolescents' problem and prosocial behaviors. Self-report and teacher ratings were obtained for 1787 (53 % female) urban middle school students. Peer pressure for fighting and friends' delinquent behavior were uniquely associated with aggression, drug use and delinquent behavior. Friends' prosocial behavior was uniquely associated with prosocial behavior. Friends' support for fighting and friends' support for nonviolence were not as clearly related to behavior. Findings were generally consistent across gender. This study highlights the importance of studying multiple aspects of peer influences on adolescents' behavior.

Prospective Association between Dieting and Smoking Initiation among Adolescents

Purpose.

To examine the relation between dieting and smoking initiation among adolescents.

Design.

Prospective data from a nationally representative study were used.

Setting.

Two waves (1994 to 1996) of the National Longitudinal Study of Adolescent Health.

Subjects.

The sample included 7795 non-Latino Caucasian and non-Latino African-American adolescents.

Measures.

Dieting status was the independent variable and trying smoking and initiation of regular smoking were the dependent variables. Covariates included age, ethnicity, overweight status, false self-perception about being overweight, and availability of cigarettes at home.

Analysis.

Logistic regression and latent transition analyses were used.

Results.

Females had a higher prevalence of dieting (55%) when compared with males (25%). Dieting initiation was a significant predictor for initiation of regular smoking among females (OR = 1.94, p = .010), but not among males. Inactive dieting was a significant predictor among males (OR = 1.74, p = .031), but not among females. Compared to nondieters, initiating and consistent female dieters reported a higher probability of trans itioning to having tried regular smoking, although results from logistic regression suggested that the association between consistent dieting and initiation of regular smoking was not significant.

Conclusions.

There is a positive relation between initiating dieting and initiating regular smoking among females, but among males it is the inactive dieters who show a positive relationship. Results illustrate the importance of examining the association between dieting and the initiation of regular smoking.

Applying the Transtheoretical Model to Tobacco Cessation and Prevention: A Review of Literature

Objective.

To comprehensively review all published, peer-reviewed research on the Transtheoretical Model (TTM) and tobacco cessation and prevention by exploring the validity of its constructs, the evidence for use of interventions based on the TTM, the description of populations using TTM constructs, and the identification of areas for further research. The three research questions answered were: “How is the validity of the TTM as applied to tobacco supported by research?” “How does the TTM describe special populations regarding tobacco use?” “What is the nature of evidence supporting the use of stage-matched tobacco interventions?”

Data Source.

Computer Database search (PsychInfo, Medline, Current Contents, ERIC, CINAHL-Allied Health, and Pro-Quest Nursing) and manual journal search.

Inclusion/Exclusion Criteria.

All English, original, research articles on the TTM as it relates to tobacco use published in peer-reviewed journals prior to March 1, 2001, were included. Commentaries, editorials, and books were not included.

Data Extraction and Synthesis.

Articles were categorized as TTM construct validation, population descriptions using TTM constructs, or intervention evaluation using TTM constructs. Summary tables including study design, research rating, purpose, methods, findings, and implications were created. Articles were further divided into groups according to their purpose. Considering both the findings and research quality of each, the three research questions were addressed.

Results.

The 148 articles reviewed included 54 validation studies, 73 population studies, and 37 interventions (some articles fit two categories). Overall, the evidence in support of the TTM as applied to tobacco use was strong, with supportive studies being more numerous and of a better design than nonsupportive studies. Using established criteria, we rated the construct validity of the entire body of literature as good; however, notable concerns exist about the staging construct. A majority of stage-matched intervention studies provided positive results and were of a better quality than those not supportive of stage-matched interventions; thus, we rated the body of literature using stage-matched tobacco interventions as acceptable and the body of literature using non–stage-matched interventions as suggestive. Population studies indicated that TTM constructs are applicable to a wide variety of general and special populations both in and outside of the United States, although a few exceptions exist.

Conclusions.

Evidence for the validity of the TTM as it applies to tobacco use is strong and growing; however, it is not conclusive. Eight different staging mechanisms were identified, raising the question of which are most valid and reliable. Interventions tailored to a smoker's stage were successful more often than nontailored interventions in promoting forward stage movement. Stage distribution is well-documented for U.S. populations; however, more research is needed for non-U.S. populations, for special populations, and on other TTM constructs.

Childhood cancer survivorship research in minority populations: A position paper from the Childhood Cancer Survivor Study

By the middle of this century, racial/ethnic minority populations will collectively constitute 50% of the US population. This temporal shift in the racial/ethnic composition of the US population demands a close look at the race/ethnicity-specific burden of morbidity and premature mortality among survivors of childhood cancer. To optimize targeted long-term follow-up care, it is essential to understand whether the burden of morbidity borne by survivors of childhood cancer differs by race/ethnicity. This is challenging because the number of minority participants is often limited in current childhood cancer survivorship research, resulting in a paucity of race/ethnicity-specific recommendations and/or interventions. Although the overall childhood cancer incidence increased between 1973 and 2003, the mortality rate declined; however, these changes did not differ appreciably by race/ethnicity. The authors speculated that any racial/ethnic differences in outcome are likely to be multifactorial, and drew on data from the Childhood Cancer Survivor Study to illustrate the various contributors (socioeconomic characteristics, health behaviors, and comorbidities) that could explain any observed differences in key treatment-related complications. Finally, the authors outlined challenges in conducting race/ethnicity-specific childhood cancer survivorship research, demonstrating that there are limited absolute numbers of children who are diagnosed and survive cancer in any one racial/ethnic minority population, thereby precluding a rigorous evaluation of adverse events among specific primary cancer diagnoses and treatment exposure groups. Cancer 2016;122:2426-2439. © 2016 American Cancer Society.

Relationships between Body Image, Body Mass Index, and Smoking in Korean Adolescents: Results of a Nationwide Korea Youth Risk Behavior Web-based Survey

OBJECTIVE

This study assessed the association between subjective body image or objective body mass index (BMI) and the risk of daily smoking in Korean adolescents, with a purpose of identifying the most suitable models.

MATERIALS AND METHODS

Using the 2013 9th Korea Youth Risk Behavior Web-based Survey data for 72,435 students, odds ratios were calculated for daily smoking in the past month, according to the subjective body image and calculated BMI using a respective multiple logistic regression model. The combined effect of these two factors was also analyzed by pairing a BMI category with a subjective body image category, using odds ratios for the same event within each sex group.

RESULTS

Among the surveyed students, 7.2% of boys and 1.8% of girls were classified as daily smokers. Students who perceived themselves as being very obese tended to be at lower risk of daily smoking (OR=0.61 in boys with 95% CI=0.47 to 0.79; OR=0.66 in women with 95% CI=0.47 to 0.93). In addition, boys within the obese or overweight BMI category showed a lower risk of daily smoking (OR=0.86, 95% CI: 0.77-0.96). Lean BMI was significantly associated with higher odds ratios for daily smoking only in female students (OR=1.24, 95% CI: 1.02-1.52). When pairing these two objective and subjective factors, results suggested that subjective body image has a greater effect on daily smoking than BMI in both boys and girls.

CONCLUSIONS

In both male and female students, subjective body image had a greater effect on daily smoking than body mass index. A model using the combination of BMI and subjective body image was the best fit in girls, in contrast to the model using subjective body image only best suitable in boys, for the prediction of daily smoking. These results including several factors associated with daily smoking in Korean students, provide useful data for the development and implementation of smoking intervention and cessation programs for adolescents.

Smoking, Adolescents and Health: Isfahan Healthy Heart Programme-Heart Health Promotion from Childhood

To evaluate the effect of some environmental factors on smoking, and to assess some health hazards of smoking in adolescents, this cross-sectional study was performed among 1950 students, ages11-18, selected by multi-stage random sampling from three cities in Iran. According to self-administered questionnaires, 12.9% of boys and 4% of girls reported to be smoker (OR=3.34, 95%CI: 2.33, 4.77, p<0.001). The mean values of total-and LDL-cholesterol were higher in smokers and their HDL-C was lower than non-smokers (163.33± 33.83, 90.73± 31 and 46.7± 12.24 vs.156± 29.53, 85±26.5 and 49.4±13.7 mg/dl, respectively, p<0.05). The mean systolic and diastolic blood pressures were higher in smokers than non-smokers (110.7± 14.5, 67.6± 11.55 vs. 104.9± 14.3, 63.2± 10.8 mmHg, respectively, p<0.05). The smokers had higher BMI than non-smokers (20.34 ±3.84 vs.19.55 ± 3.66, p<0.05). The mean food consumption frequency was lower for fruits and vegetables and higher for fat/salty snacks and fast foods in smokers than non-smokers. Logistic regression analysis showed significant association between sex, age, the number of family members and number of smokers in the family and smoking in students. The findings of this study have implications for future tobacco prevention strategies through community-based interventions. Asia Pac JPublic Health 2004; 16(1): 15-22.

The Jackson Heart KIDS Pilot Study: Theory-Informed Recruitment in an African American Population

Recruitment for large cohort studies is typically challenging, particularly when the pool of potential participants is limited to the descendants of individuals enrolled in a larger, longitudinal "parent" study. The increasing complexity of family structures and dynamics can present challenges for recruitment in offspring. Few best practices exist to guide effective and efficient empirical approaches to participant recruitment. Social and behavioral theories can provide insight into social and cultural contexts influencing individual decision-making and facilitate the development strategies for effective diffusion and marketing of an offspring cohort study. The purpose of this study was to describe the theory-informed recruitment approaches employed by the Jackson Heart KIDS Pilot Study (JHKS), a prospective offspring feasibility study of 200 African American children and grandchildren of the Jackson Heart Study (JHS)-the largest prospective cohort study examining cardiovascular disease among African American adults. Participant recruitment in the JHKS was founded on concepts from three theoretical perspectives-the Diffusion of Innovation Theory, Strength of Weak Ties, and Marketing Theory. Tailored recruitment strategies grounded in participatory strategies allowed us to exceed enrollment goals for JHKS Pilot Study and develop a framework for a statewide study of African American adolescents.

Body image emotions, perceptions, and cognitions distinguish physically active and inactive smokers

Objectives

To determine if body image emotions (body-related shame and guilt, weight-related stress), perceptions (self-perceived overweight), or cognitions (trying to change weight) differ between adolescents characterized by smoking and physical activity (PA) behavior.

Methods

Data for this cross-sectional analysis were collected in 2010–11 and were available for 1017 participants (mean (SD) age = 16.8 (0.5) years). Participants were categorized according to smoking and PA status into four groups: inactive smokers, inactive non-smokers, active smokers and active non-smokers. Associations between body image emotions, perceptions and cognitions, and group membership were estimated in multinomial logistic regression.

Results

Participants who reported body-related shame were less likely (OR (95% CI) = 0.52 (0.29–0.94)) to be in the active smoker group than the inactive smoker group; those who reported body-related guilt and those trying to gain weight were more likely (2.14 (1.32–3.48) and 2.49 (1.22–5.08), respectively) to be in the active smoker group than the inactive smoker group; those who were stressed about weight and those perceiving themselves as overweight were less likely to be in the active non-smoker group than the inactive smoker group (0.79 (0.64–0.97) and 0.41 (0.19–0.89), respectively).

Conclusion

Body image emotions and cognitions differentiated the active smoker group from the other three groups.

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We examined body image in physically active adolescent smokers.

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Body-related shame and guilt were related to being a physically active smoker.

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Trying to gain weight was also associated with being a physically active smoker.

•

Body image emotions and cognitions differentiate physically active smokers.

The Demand for Cigarettes as Derived from the Demand for Weight Loss: A Theoretical and Empirical Investigation

This paper offers an economic model of smoking and body weight and provides new empirical evidence on the extent to which the demand for cigarettes is derived from the demand for weight loss. In the model, smoking causes weight loss in addition to having direct utility benefits and direct health consequences. It predicts that some individuals smoke for weight loss and that the practice is more common among those who consider themselves overweight and those who experience greater disutility from excess weight. We test these hypotheses using nationally representative data in which adolescents are directly asked whether they smoke to control their weight. We find that, among teenagers who smoke frequently, 46% of girls and 30% of boys are smoking in part to control their weight. As predicted by the model, this practice is significantly more common among those who describe themselves as too fat and among groups that tend to experience greater disutility from obesity. We conclude by discussing the implications of these findings for tax policy; specifically, the demand for cigarettes is less price elastic among those who smoke for weight loss, all else being equal. Public health efforts to reduce smoking initiation and encourage cessation may wish to design campaigns to alter the derived nature of cigarette demand, especially among adolescent girls.

Associations between unhealthy dieting behaviors and tobacco use among adolescents

BACKGROUND

Cigarette smoking is an important risk factor for unhealthy dieting behaviors (UDBs) in youth. The role of alternative tobacco products and UDB engagement has yet to be examined empirically despite concerning trends in use. This study aimed to examine UDB prevalence in a U.S. geographic region-specific adolescent sample and associations with a variety of tobacco use behaviors and perceptions.

METHODS

Weighted data from the 2013 Virginia Youth Survey were analyzed (n = 6903). UDBs assessed included past 30-day fasting, diet pill use, and vomiting/laxative use. Tobacco-related items were ever and past 30-day cigarette smoking, past 30-day smokeless tobacco and cigar use, and the perception that smokers have more friends. UDB prevalence was recoded by the number of behaviors endorsed (0, 1, and 2+). Bivariate and multinomial regression models were used to examine associations between covariates and number of UDBs endorsed by gender.

RESULTS

Overall, nearly 16% engaged in at least one UDB. Fasting was most prevalent (14.2%) followed by vomiting/laxative (7.0%) and diet pill use (6.1%). Across gender, ever cigarette smoking, past 30-day cigar use, and the perception that smokers have more friends were positively associated with UDB engagement in relative isolation as well as in combination.

CONCLUSIONS

Findings highlight the importance of tobacco-related factors for weight control behaviors and are the first to identify an association between UDB incidence and an alternative tobacco product, cigars. This work should inform prevention efforts for tobacco use and UDBs and underscores the need to address the use of any tobacco for weight control.

A Primer on the Genetics of Comorbid Eating Disorders and Substance Use Disorders

Eating disorders (EDs) and substance use disorders (SUDs) frequently co-occur; however, the reasons for this are unclear. We review the current literature on genetic risk for EDs and SUDs, as well as preliminary findings exploring whether these classes of disorders have overlapping genetic risk. Overall, genetic factors contribute to individual differences in liability to multiple EDs and SUDs. Although initial family studies concluded that no shared familial (which includes genetic) risk between EDs and SUDs exists, twin studies suggest a moderate proportion of shared variance is attributable to overlapping genetic factors, particularly for those EDs characterized by binge eating and/or inappropriate compensatory behaviours. No adoption or molecular genetic studies have examined shared genetic risk between these classes of disorders. Research investigating binge eating and inappropriate compensatory behaviours using emerging statistical genetic methods, as well as examining gene-environment interplay, will provide important clues into the aetiology of comorbid EDs and SUDs.

Bulimic Behaviors and Early Substance Use: Findings from a Cotwin-Control Study

BACKGROUND

Bulimic behaviors (i.e., binge eating and compensatory behaviors) and substance use frequently co-occur. However, the etiology underlying this association is poorly understood. This study evaluated the association between bulimic behaviors and early substance use, controlling for genetic and shared environmental factors.

METHODS

Participants were 3,540 young adult women from the Missouri Adolescent Female Twin Study. A telephone adaptation of the Semi-Structured Assessment for the Genetics of Alcoholism interview assessed DSM-IV bulimic behaviors, substance use, and other psychological characteristics. Lifetime bulimic behaviors were examined in twin pairs concordant and discordant for early substance use. Logistic regressions were adjusted for the nonindependence of twin data, zygosity, age, body mass index, early menarche (onset before age 12), and early sex (first consensual sexual intercourse before age 15).

RESULTS

In the entire study population, women who reported early use of alcohol or nicotine were more likely to engage in bulimic behaviors after adjusting for covariates. In 53 pairs of monozygotic twins discordant for alcohol experimentation before age 15, the twin who reported early alcohol experimentation had 3.21 (95% confidence interval = 1.54 to 6.67) times higher odds of reporting bulimic behaviors than the cotwin who did not report early alcohol experimentation, even after adjustment for covariates.

CONCLUSIONS

Findings suggest that early alcohol experimentation may contribute to the development of bulimic behaviors via mechanisms extending beyond shared vulnerability, including individual-specific environmental experiences or causal pathways.

Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic

Physiological mechanisms promote weight gain after famine. Because eating disorders, obesity, and dieting limit food intake, they are famine-like experiences. The development of the concept of meeting an ideal weight was the beginning of increasing obesity. Weight stigma, the perception of being fat, lack of understanding of normal growth and development, and increased concern about obesity on the part of health providers, parents, and caregivers have reinforced each other to promote dieting. Because weight suppression and disinhibition provoke long-term weight increase, dieting is a major factor producing the obesity epidemic. The integrated eating disorder-obesity theory included in this article emphasizes that, contrary to dieters, lifetime weight maintainers depend on physiological processes to control weight and experience minimal weight change.

Smoking in infertile women with polycystic ovary syndrome: baseline validation of self-report and effects on phenotype

STUDY QUESTION

Do women with polycystic ovary syndrome (PCOS) seeking fertility treatment report smoking accurately and does participation in infertility treatment alter smoking?

SUMMARY ANSWER

Self-report of smoking in infertile women with PCOS is accurate (based on serum cotinine levels) and smoking is unlikely to change over time with infertility treatment.

WHAT IS KNOWN ALREADY

Women with PCOS have high rates of smoking and it is associated with worse insulin resistance and metabolic dysfunction.

STUDY DESIGN, SIZE, DURATION

Secondary study of smoking history from a large randomized controlled trial of infertility treatments in women with PCOS (N = 626) including a nested case-control study (N = 148) of serum cotinine levels within this cohort to validate self-report of smoking.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Women with PCOS, age 18-40, seeking fertility who participated in a multi-center clinical trial testing first-line ovulation induction agents conducted at academic health centers in the USA.

MAIN RESULTS AND THE ROLE OF CHANCE

Overall, self-report of smoking in the nested case-control study agreed well with smoking status as determined by measure of serum cotinine levels, at 90% or better for each of the groups at baseline (98% of never smokers had cotinine levels <15 ng/ml compared with 90% of past smokers and 6% of current smokers). There were minor changes in smoking status as determined by serum cotinine levels over time, with the greatest change found in the smoking groups (past or current smokers). In the larger cohort, hirsutism scores at baseline were lower in the never smokers compared with past smokers. Total testosterone levels at baseline were also lower in the never smokers compared with current smokers. At end of study follow-up insulin levels and homeostatic index of insulin resistance increased in the current smokers (P < 0.01 for both) compared with baseline and with non-smokers. The chance for ovulation was not associated with smoking status, but live birth rates were increased (non-significantly) in never or past smokers.

LIMITATIONS, REASONS FOR CAUTION

The limitations include the selection bias involved in our nested case-control study, the possibility of misclassifying exposure to second hand smoke as smoking and our failure to capture self-reported changes in smoking status after enrollment in the trial.

WIDER IMPLICATIONS OF THE FINDINGS

Because self-report of smoking is accurate, further testing of smoking status is not necessary in women with PCOS. Because smoking status is unlikely to change during infertility treatment, extra attention should be focused on smoking cessation in current or recent smokers who seek or who are receiving infertility treatment.

STUDY FUNDING/COMPETING INTERESTS

Sponsored by the Eugene Kennedy Shriver National Institute of Child Health and Human Development of the U.S. National Institutes of Health.

CLINICAL TRIAL REGISTRATION NUMBERS

ClinicalTrials.gov numbers, NCT00068861 and NCT00719186.

The relationship between weight and smoking in a national sample of adolescents: Role of gender

This study sought to investigate the role of weight status and body mass index percentile in risky smoking behaviors in male and female adolescents. Analyses of the data obtained in the 2011 Youth Risk Behavior Surveillance System were conducted. The national sample size included 15,425 adolescents. Questions addressing weight status and smoking behaviors were used in analyses. Significant effects of perceived weight status, weight change status, and body mass index percentile on smoking behaviors were found for both genders. The current findings indicate the importance of accounting for both gender and weight status when developing prevention and cessation programs targeting smoking behaviors.

Assessing the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity

OBJECTIVE

This study aimed to examine the prevalence of and factors associated with overweight, obesity, and binge eating as a function of ethnicity among a national sample of college students.

METHODS

Data were drawn from the 2010 Healthy Minds Study sample. Participants were 24,396 college students from 26 colleges and universities. This sample included 62 % females and a broad range of ethnic backgrounds; 30 % were overweight, 10 % were obese, and 7 % met criteria the for binge eating.

RESULTS

While African Americans reported the highest prevalence of overweight (49 %) and obesity (24 %), Arab-Americans reported the highest prevalence of binge eating (10 %). The factors associated with weight problems and binge eating differed by ethnicity.

CONCLUSIONS

Research is warranted to develop more culturally sensitive interventions to target those ethnic minorities at elevated risk. Further study of binge eating among Arab-Americans is particularly important, as the prevalence of this condition was higher among this group over any other.

Factors associated with tobacco smoking and the belief about weight control effect of smoking among Hungarian adolescents

INTRODUCTION

The relationship between body weight and smoking has been well-documented among adult populations, but the data among youth are inconsistent. This study explores the relationship among social, behavioural, body weight-related factors and adolescent smoking while identifying factors associated with the belief that smoking controls weight.

MATERIALS AND METHODS

Baseline data from a three-year, prospective cohort study started in 2009 in Hungary's six metropolitan cities. Randomly selected 6th and 9th grade students completed a self-administered questionnaire during the 2009-2010 school year (n = 1445; 45% boys, mean age of 6th graders: 12.06 years, SD = 0.63; mean age of 9th graders: 15.06 years, SD = 0.63). Calculations of Body Mass Index (BMI) were based on objectively measured weight and height data of participants. Appetite-Weight Control Scale of the Short Form of Smoking Consequences Questionnaire was used to measure the belief that smoking supports weight control. Bivariate and multivariate logistic regression analyses were performed to examine the association between the perception of weight control and smoking, while controlling for potential confounding variables (e.g., gender).

RESULTS

24.8% of participants smoked cigarettes within the past 30 days. The odds of smoking were increased among students who were older, had smoking friends, were exposed to parental smoking, and had poorer academic performance. BMI showed positive association with smoking (increases in BMI were associated with higher odds of smoking), and the belief that smoking controls weight mediated this association. There was no difference in smoking prevalence among those motivated either to lose or gain weight (approximately 30%), but was considerably lower among adolescents satisfied with their body weight (19%). The belief that smoking supports weight control was more common for girls, older students, and those who perceived themselves as overweight.

CONCLUSIONS

Dissatisfaction with body weight and the belief that smoking has weight controlling effects are associated with an increased likelihood of adolescent smoking, therefore they must be considered in smoking prevention programmes among youth.

Association of Sleep Duration with Obesity among US High School Students

Increasing attention is being focused on sleep duration as a potential modifiable risk factor associated with obesity in children and adolescents. We analyzed data from the national Youth Risk Behavior Survey to describe the association of obesity (self-report BMI ≥95th percentile) with self-reported sleep duration on an average school night, among a representative sample of US high school students. Using logistic regression to control for demographic and behavioral confounders, among female students, compared to 7 hours of sleep, both shortened (≤4 hours of sleep; adjusted odds ratio (95% confidence interval), AOR = 1.50 (1.05-2.15)) and prolonged (≥9 hours of sleep; AOR = 1.54 (1.13-2.10)) sleep durations were associated with increased likelihood of obesity. Among male students, there was no significant association between obesity and sleep duration. Better understanding of factors underlying the association between sleep duration and obesity is needed before recommending alteration of sleep time as a means of addressing the obesity epidemic among adolescents.

The influence of worries on emotional eating, weight concerns, and body mass index in Latina female youth

PURPOSE

To investigate the effect of worries on weight concerns, emotional eating, and body mass index (BMI) percentile in an ethnically diverse sample of female youth.

METHODS

This study used baseline and follow-up data from a brief school-based physical activity intervention trial involving minority female youth. Partial correlations adjusted for intervention status, age, and ethnicity were used to assess the relationships between emotional eating, weight concerns, and BMI percentile at follow-up. Multilevel modeling was used to analyze the relationships between baseline worries and follow-up emotional eating, weight concerns, and BMI percentile. Additional analysis assessed whether emotional eating mediated and/or moderated the relationship between baseline worries and follow-up BMI. Data were analyzed using SAS version 9.1.

RESULTS

The sample consisted of 404 minority females (67.1% Latina; mean age = 12.5 ± .6; 60.6% were of normal weight). Weight concerns were positively correlated with emotional eating and BMI percentile (p < .001 for both). At follow-up, baseline worries significantly predicted emotional eating (p = .027) and weight concerns (p < .001) but not BMI percentile (p = .183). Emotional eating did not mediate the relationship between baseline worries and follow-up BMI percentile; however, it did moderate the relationship between baseline worries and follow-up BMI percentile (p = .003).

CONCLUSIONS

In this sample, worries were associated with psychosocial variables but not with BMI percentile. Reducing worries in those with high emotional eating scores may influence future weight gain among Latina females.

Dizziness and the genetic influences on subjective experiences to initial cigarette use

AIM

To examine individual differences in positive and negative subjective experiences to initial cigarette use.

DESIGN

Retrospective self-reports of initial subjective experiences were examined to estimate the genetic and environmental influences and the extent of their covariation across different effects.

PARTICIPANTS

Data was drawn from 2482 young adult same-and opposite sex twins- and siblings participating in the National Longitudinal Study of Adolescent Health.

MEASUREMENT

Subjective experiences were retrospectively collected using the Early Smoking Experience (ESE) questionnaire.

FINDINGS

Positive experiences evidenced moderate heritable contributions (40%, 95% CI: 0.22 to 0.56), as did an overall hedonic measure (34%, 95% CI: 0.22 to 0.46) and dizziness (34%, 95% CI: 0.15 to 0.52). Negative experiences evidenced small heritable contributions (13%, 95% CI: 0.00 to 0.36). Individual specific environmental influences were strong and accounted for the remaining proportion of observed variation in these experiences. Multivariate genetic modeling identified a moderately heritable underlying factor (37%, 95% CI: 0.22 to 0.52) that influenced the covariation of diverse subjective experiences and loaded most heavily on dizziness. Positive experiences also evidence residual genetic influences that were uncorrelated with other subjective experiences.

CONCLUSIONS

How a person experiences their initial few cigarettes is due to both heritable contributions and environmental experiences unique to the person. The covariation of diverse subjective experiences appears to be due to a heritable latent sensitivity to the chemicals contained in an average cigarette and is best indexed by dizziness.

Smoking correlates among Hispanic and non-Hispanic white adolescents in the US southwest

We examined smoking correlates among Hispanic and white students in 6-12th grades in small communities in three states in the southwestern United States. Data were collected in 2002 from 8,479 participants, who completed surveys measuring a wide range of potential smoking correlates from individual, family, and peer domains. Logistic regression analyses showed that peer factors were the most robust correlates across both ethnicities and grade groups. An unexpected finding was the posited protective effect of male gender for older white students. Limitations and implications for prevention are discussed. This work was supported by the National Institute on Drug Abuse.

Disordered eating and substance use among a female sample of Mexican adolescents

The relation between disordered eating and substance use was examined among Mexican female adolescents in a probabilistic sample of 2537 high school students in central Mexico, stratified by marginalization status and migratory intensity, obtained during 2006 ?2007 school year. The Brief Disordered Eating Questionnaire and the World Health Organization and United Nations Division of Narcotic Drugs recommendations for substance use assessments were used. Prevalence and odds ratios for disordered eating and substance use items were calculated separately across low and high marginalization groups. Study's implications and limitations are noted, as well as future research and prevention strategies are suggested.

Adolescent's weight concerns and the onset of smoking

The hypothesis that adolescents start smoking because they perceive it as a strategy to control their weight was examined. At the same time, we controlled for sociodemographic, individual, and parental factors. Longitudinal data were collected among 428 Dutch families (mother, father, and two siblings between 13 and 16 years of age) in two measurements: the first in 2002-2003 and the second a year later. Logistic regression analyses supported the hypothesis: weight control motives to smoke were positively related with smoking initiation. The study's limitations and implications are discussed.

Smoking expectancies, weight concerns, and dietary behaviors in adolescence

OBJECTIVE

The objective of this study was to examine the association of cigarette smoking and weight concerns in adolescents, given that adolescents may begin smoking or have difficulty quitting because of their expectancies of the effects of smoking on body weight.

METHODS

This study used data from a cross-sectional survey of 4523 Connecticut high school adolescents to assess the influence of gender, smoking intensity, and dietary-restrictive behavior on smoking-related weight concerns.

RESULTS

Heavy smokers were significantly less likely to engage in healthy dietary restrictions than nonsmokers; however, light smokers did not differ from nonsmokers. Both light and heavy smokers were significantly more likely to engage in unhealthy dietary restriction when compared with nonsmokers. In the model that was used to examine smokers only, heavy smokers were significantly less likely to engage in healthy dietary restriction than light smokers, but smoking level was not associated with unhealthy dietary restrictions. Dietary restrictions are significantly associated with smoking-related weight concerns; however, this seems to be related to type of dietary-restrictive behavior, with greater weight concerns observed only in those smokers who engaged in unhealthy dietary restrictions and not in those who engaged in healthy dietary restrictions or no restrictions.

CONCLUSIONS

Although limited by its cross-sectional nature, the findings from this large, geographically diverse sample have clinical implications for smoking prevention and cessation interventions in adolescents.

Weight control behaviors among overweight, normal weight and underweight adolescents in Palestine: findings from the national study of Palestinian schoolchildren (HBSC-WBG2004)

OBJECTIVE

The objective of the study is to examine the relationship between weight-control behaviors and self-reported sociodemographic characteristics, weight status, and perception of body weight in a large, representative sample of adolescents in the West Bank and Gaza Strip territories of Palestine.

METHOD

Self-report measures of sociodemographic characteristics, body weight perception, height and weight, and weight-control behaviors were completed by 8,885 male and female students aged 12-18 years from 405 randomly selected schools as part of the 2003/2004 Palestinian Health Behavior in School-aged Children Study (HBSC).

RESULTS

In both genders, dieting to lose weight was common among adolescents and significantly higher among overweight than among underweight or normal weight adolescents. Extreme weight-control behaviors (vomiting, diet pills, or laxatives) and smoking were more common among boys than girls, and extreme weight-control behaviors were particularly common among underweight boys. Older adolescents were less likely than younger adolescents to engage in weight-control behaviors. Perception of body weight as too fat was an influential factor in following an unhealthy diet to lose weight.

DISCUSSION

Practices to control weight, particularly extreme and unhealthy weight-control behaviors, are common among adolescents in the Palestinian territories. These findings suggest the need to design appropriate prevention and early intervention programs for adolescents in Palestine.

Association between tobacco use and lifestyle in a sample of lower income urban African-Americans in the American south

There has been little research evaluating links between low-income populations' lifestyles and their tobacco use status. We surveyed 398 low-income individuals living in Housing Authority complexes in Columbus, Georgia. Current, former, and never tobacco users were compared for their health-related behaviors and lifestyles. Study findings suggest that current tobacco users were less healthy than comparisons, but had less unfavorable obesity measurements. In lifestyle choices, tobacco users were more likely than comparisons to be interested in sports (football, basketball, etc.), shopping, and participate in church activities.

From the American Academy of Pediatrics: Technical report--Secondhand and prenatal tobacco smoke exposure

Secondhand tobacco smoke (SHS) exposure of children and their families causes significant morbidity and mortality. In their personal and professional roles, pediatricians have many opportunities to advocate for elimination of SHS exposure of children, to counsel tobacco users to quit, and to counsel children never to start. This report discusses the harms of tobacco use and SHS exposure, the extent and costs of tobacco use and SHS exposure, and the evidence that supports counseling and other clinical interventions in the cycle of tobacco use. Recommendations for future research, policy, and clinical practice change are discussed. To improve understanding and provide support for these activities, the harms of SHS exposure are discussed, effective ways to eliminate or reduce SHS exposure are presented, and policies that support a smoke-free environment are outlined.

From the American Academy of Pediatrics: Policy statement--Tobacco use: a pediatric disease

Tobacco use and secondhand tobacco-smoke (SHS) exposure are major national and international health concerns. Pediatricians and other clinicians who care for children are uniquely positioned to assist patients and families with tobacco-use prevention and treatment. Understanding the nature and extent of tobacco use and SHS exposure is an essential first step toward the goal of eliminating tobacco use and its consequences in the pediatric population. The next steps include counseling patients and family members to avoid SHS exposures or cease tobacco use; advocacy for policies that protect children from SHS exposure; and elimination of tobacco use in the media, public places, and homes. Three overarching principles of this policy can be identified: (1) there is no safe way to use tobacco; (2) there is no safe level or duration of exposure to SHS; and (3) the financial and political power of individuals, organizations, and government should be used to support tobacco control. Pediatricians are advised not to smoke or use tobacco; to make their homes, cars, and workplaces tobacco free; to consider tobacco control when making personal and professional decisions; to support and advocate for comprehensive tobacco control; and to advise parents and patients not to start using tobacco or to quit if they are already using tobacco. Prohibiting both tobacco advertising and the use of tobacco products in the media is recommended. Recommendations for eliminating SHS exposure and reducing tobacco use include attaining universal (1) smoke-free home, car, school, work, and play environments, both inside and outside, (2) treatment of tobacco use and dependence through employer, insurance, state, and federal supports, (3) implementation and enforcement of evidence-based tobacco-control measures in local, state, national, and international jurisdictions, and (4) financial and systems support for training in and research of effective ways to prevent and treat tobacco use and SHS exposure. Pediatricians, their staff and colleagues, and the American Academy of Pediatrics have key responsibilities in tobacco control to promote the health of children, adolescents, and young adults.

From the American Academy of Pediatrics: Technical report--Tobacco as a substance of abuse

Tobacco use is the leading preventable cause of morbidity and death in the United States. Because 80% to 90% of adult smokers began during adolescence, and two thirds became regular, daily smokers before they reached 19 years of age, tobacco use may be viewed as a pediatric disease. Every year in the United States, approximately 1.4 million children younger than 18 years start smoking, and many of them will die prematurely from a smoking-related disease. Moreover, there is recent evidence that adolescents report symptoms of tobacco dependence early in the smoking process, even before becoming daily smokers. The prevalence of tobacco use is higher among teenagers and young adults than among older adult populations. The critical role of pediatricians in helping to reduce tobacco use and addiction and secondhand tobacco-smoke exposure in the pediatric population includes education and prevention, screening and detection, and treatment and referral.

Associations of trying to lose weight, weight control behaviors, and current cigarette use among US high school students

BACKGROUND

Approximately one-quarter of high school students currently use cigarettes. Previous research has suggested some youth use smoking as a method for losing weight. The purpose of this study was to describe the association of current cigarette use with specific healthy and unhealthy weight control practices among 9th-12th grade students in the United States.

METHODS

Youth Risk Behavior Survey data (2005) were analyzed. Behaviors included current cigarette use, trying to lose weight, and current use of 2 healthy and 3 unhealthy behaviors to lose weight or to keep from gaining weight. Separate logistic regression models calculated adjusted odds ratios (AORs) for associations of current cigarette use with trying to lose weight (Model 1) and the 5 weight control behaviors, controlling for trying to lose weight (Model 2).

RESULTS

In Model 1, compared with students who were not trying to lose weight, students who were trying to lose weight had higher odds of current cigarette use (AOR = 1.30, 95% CI: 1.15-1.49). In Model 2, the association of current cigarette use with the 2 healthy weight control behaviors was not statistically significant. Each of the 3 unhealthy weight control practices was significantly associated with current cigarette use, with AORs for each behavior approximately 2 times as high among those who engaged in the behavior, compared with those who did not.

CONCLUSION

Some students may smoke cigarettes as a method of weight control. Inclusion of smoking prevention messages into existing weight management interventions may be beneficial.

Psychological determinants of emotional eating in adolescence

Emotional eating is conceptualized as eating in response to negative affect. Data from a larger study of physical activity was employed to examine the associations among specific emotions/moods and emotional eating in an adolescent sample. Six-hundred and sixty-six students of diverse backgrounds from 7 middle schools in Los Angeles County participated. Cross-sectional analysis revealed no gender differences in emotional eating, and showed that perceived stress and worries were associated with emotional eating in the total sample. Gender stratified analyses revealed significant associations of perceived stress, worries and tension/anxiety to emotional eating for girls, while only confused mood was related to emotional eating in boys. These findings bear potential implications for the treatment and prevention of pediatric obesity and eating disorders because they suggest that interventions would benefit from incorporation of stress-reduction techniques and promotion of positive mood.

Health risks information reaches secondary school smokers

This cross-sectional study aimed to assess smoking prevention and cessation education delivered as part of the UK National Curriculum and to evaluate the relative effectiveness of health, social influence and other/non-health components. In all, 1789 students aged 11-15 from 12 secondary schools completed online surveys assessing smoking status, factors known to be related to smoking and experience of smoking education. A total of 1421 of 1722 (83%) students remembered some school-based education. Of these, 803 (57%) said that the lessons changed their ideas about smoking. Multinomial logistic regression was used to assess whether lesson recall was associated with smoking status in a model adjusting for age, gender, ethnicity, family and best friend smoking status, socioeconomic status, and school. Quitters were more likely than smokers to report having changed their ideas about smoking as a result of a lesson (OR 5.78, 95% CI 2.44-13.72). The relative effectiveness of 16 lesson themes was assessed. Significantly more students changed their ideas about smoking as a result of 'health' compared with 'social influence' (chi(2) (1) 124.0, P < 0.001) or 'other/non-health' (chi(2) (1) 63.16, P < 0.001) topics. Mouth cancer was the most effective health topic and may provide a suitable model for both smoking and risky drinking prevention.

Intentional weight loss and mortality among initially healthy men and women

Most prospective observational studies suggest that weight loss increases the risk of premature death among obese individuals. This is surprising because clinical studies show that weight loss generally leads to overall improvements in cardiovascular risk factors. It is sometimes argued that the increased mortality observed with weight loss must depend on confounding or poor study designs. This review was conducted to summarize results from studies on intentional weight loss and mortality among healthy individuals, while carefully considering the designs and problems in these studies. Evaluation criteria with a rating scale were developed. Of the studies evaluated, two found decreased mortality with intentional weight loss, three found increased mortality, and four found no significant associations between intentional weight loss and total mortality. Thus, it is still not possible for health authorities to make secure recommendations on intentional weight loss. More studies designed to specifically address this issue are warranted.

Predictors of regular cigarette smoking among adolescent females: does body image matter?

This study examined how factors associated with body image predict regular smoking in adolescent females. Data were from the National Longitudinal Study of Adolescent Health (Add Health), a study of health-related behaviors in a nationally representative sample of adolescents in grades 7 through 12. Females in Waves I and II (n = 6,956) were used for this study. Using SUDAAN to adjust for the sampling frame, univariate and multivariate analyses were performed to investigate if baseline body image factors, including perceived weight, perceived physical development, trying to lose weight, and self-esteem, were predictive of regular smoking status 1 year later. In univariate analyses, perceived weight (p<.01), perceived physical development (p<.0001), trying to lose weight (p<.05), and self-esteem (p<.0001) significantly predicted regular smoking 1 year later. In the logistic regression model, perceived physical development (p<.05), and self-esteem (p<.001) significantly predicted regular smoking. The more developed a female reported being in comparison to other females her age, the more likely she was to be a regular smoker. Lower self-esteem was predictive of regular smoking. Perceived weight and trying to lose weight failed to reach statistical significance in the multivariate model. This current study highlights the importance of perceived physical development and self-esteem when predicting regular smoking in adolescent females. Efforts to promote positive self-esteem in young females may be an important strategy when creating interventions to reduce regular cigarette smoking.

Does cigarette use influence adiposity or height in adolescence?

PURPOSE

To study the effect of cigarette use on height and adiposity in adolescents.

METHODS

Data on cigarette use were collected every 3 months for 5 years from adolescents initially 12-13 years of age. Height, weight, and triceps skinfold thickness were measured in survey cycles 1, 12, and 19. Multivariate linear regression models were fitted to estimate the association between cigarette use and the anthropometric measures in a dataset that pooled data over two time periods, from survey cycles 1-12 and from survey cycles 12-19.

RESULTS

Data were available for 451 boys and 478 girls. Seven percent of boys and 14% of girls smoked > or =30 cigarettes per month on average during the first time period; 9% of boys and 18% of girls smoked > or =30 cigarettes per month on average during the second time period. In boys, a 100-cigarette per month increment in cigarette use over the preceding 2.5 years was independently associated with lower body mass index (-0.4 kg/m(2)) and shorter height (-0.7 cm). In girls, cigarette use was not associated with height or adiposity.

CONCLUSIONS

While there was no relation in girls, cigarette use appears to decrease body mass index and height in boys. Young girls may be less likely to take up cigarette smoking if tobacco control messages emphasize that cigarette use may not be associated with reduced weight in adolescent females.